Treatment of Primary Myelofibrosis in Anemia with Serum Erythropoietin Below 500 mU/mL

When primary myelofibrosis presents alongside anemia, absence of the del(5q) abnormality, and a serum erythropoietin level below 500 mU/mL, this specific combination defines a patient population for whom a targeted anemia-directed approach is appropriate.

Clinical Scenario

This protocol applies when all of the following are confirmed:

Anemia
No del(5q) chromosomal abnormality
Serum erythropoietin <500 mU/mL

Treatment Goal

The primary objective is an anemia response — defined as transfusion cessation in previously transfusion-dependent patients, or a hemoglobin increase of 2 g/dL or greater in patients who are transfusion-independent.

Approach

Management in this setting involves a class of agents that act on red blood cell production — the full selection criteria, sequencing, and monitoring parameters are detailed in the complete protocol.

Specific options and the complete regimen are available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

Anemia
EPO <500 mU/mL
ESAs
Erythropoiesis-stimulating agents allowed anemia responses in 53% of 163 patients (29% in patients with TD, 57% in patients with TI), with a median DOR of 19 months regardless of concomitant JAKi.
Anemia response is usually defined according to the International Working Group on Myeloproliferative Neoplasms Research and treatment (IWGMRT) criteria: transfusion cessation if previous RBC transfusion dependency (TD), or hemoglobin increase ≥2 g/dL (modifiable in 1.5 g/dL) in case of RBC transfusion independency (TI).

DOI: 10.1182/blood.2022017423

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